Podcast 90: Preventing type 2 diabetes with low-dose metformin and rosiglitazone seems possible, but clinical use has to await results of another study.

Here’s a question wrapped in mist: How to prevent diabetes? Well, lifestyle changes for sure, but that’s hard. Drug therapy? Easier, but side effects can take away that advantage pretty quickly. Rosiglitazone offers some benefits, but its side effects — most notably increased risks for heart failure and death — have some people wondering whether it should stay on the market.

Canadian researchers took the approach of using low doses of rosiglitazone and metformin in combination. They compared that treatment with placebo in a small group of 200 patients with impaired glucose tolerance. Those receiving treatment had a much lower risk of developing type 2 diabetes over the ensuing 4 years of follow-up.

The results aren’t anywhere near ready for allowing clinical use, but they at least move us a bit through the fog. Our conversation this week is with Bernard Zinman, the principal author of the study, just published in the Lancet.